Digital Loss (Gangrene, Amputation, Autoamputation)
Digital loss is the most serious and fearful complication of digital ulcers (DUs) in systemic sclerosis (SSc). It may occur as a consequence of gangrene that leads to an autoamputation or to surgical amputation or as a result of amputation performed for other reasons, as severe osteomyelitis.
It has been estimated that 5–10% of all SSc patients develops gangrene or undergo amputation (Steen et al. Rheumatology (Oxford) 48(Suppl 3):S19–S24, 2009; Poormoghim et al. Rheumatol Int 33(8):1943–1950, 2013; Muangchan et al. J Rheumatol 40(9):1545–1556, 2013). The risk of gangrene and amputation increases to 20% in patients with DUs (Denton et al. Ann Rheum Dis. 2012;71(5):718-21; Hachulla et al. J Rheumatol 2007;34:2423–30; Allanore et al. Ann Rheum Dis2015;74(Suppl2): 818), while the incidence of amputation ranges from 1% to 2% of patients/year (Denton et al. Ann Rheum Dis. 2012;71(5):718-21; Hachulla et al. J Rheumatol 2007;34:2423–30).
This chapter will describe causes and features of gangrene which represents the major cause of digital loss in SSc, as well as causes and complications of amputation and autoamputation.
KeywordsSystemic sclerosis Digital loss Gangrene Amputation Autoamputation
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